NPIMap

Organization Active NPI

Lake Shore Physical Therapy, P.C.

  • Physical Therapist
  • Ronkonkoma, NY
National Provider Identifier
1871951996
Registry record updated Feb 3, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
005760-1 Issued in NY
Legal business name
LAKE SHORE PHYSICAL THERAPY, P.C.
Practice address
700 Union Pkwy
Suite 3
Ronkonkoma, NY 11779-7427
Phone
(516) 731-3583
Fax
(516) 731-3587
NPI assigned
Feb 3, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Sean C. Serpe
Title
Practice Manager
Phone
(516) 731-3583

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 005760-1 NY Primary

Addresses

Primary practice location

700 Union Pkwy
Suite 3
Ronkonkoma, NY 11779-7427

Mailing address

4277 Hempstead Tpke
Suite 209a
Bethpage, NY 11714-5709
Phone (516) 731-3583

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 19

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1454457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454457600000",
    "number": "1871951996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4277 HEMPSTEAD TPKE",
            "address_2": "SUITE 209A",
            "city": "BETHPAGE",
            "state": "NY",
            "postal_code": "117145709",
            "telephone_number": "516-731-3583",
            "fax_number": "516-731-3587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 UNION PKWY",
            "address_2": "SUITE 3",
            "city": "RONKONKOMA",
            "state": "NY",
            "postal_code": "117797427",
            "telephone_number": "516-731-3583",
            "fax_number": "516-731-3587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE SHORE PHYSICAL THERAPY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-03",
        "last_updated": "2016-02-03",
        "status": "A",
        "authorized_official_last_name": "SERPE",
        "authorized_official_first_name": "SEAN",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "516-731-3583",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "005760-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ronkonkoma, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.